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colonoscopy code

  1. #1
    Location
    East Valley, Tempe AZ
    Posts
    44
    Default colonoscopy code
    Medical Coding Books
    I have a question regarding G0105/G0121 v. 45378.
    The G codes pays less money(only on the facility side) and when I went to the CMS website it said you should use the G codes not that you have to. Asking other billers and coders in the area I got a lot of different responses. One facility always changes to the G code. Another response I received was a colonoscopy is colonoscopy and it is the dx code that is the driving force (then why the difference in pymt). Another person said that what I read on the CMS website is a guideline and not a rule. So just wanting to know what everyone else is doing.
    Thanks for the input.
    Lora M. Crawford, CPC

  2. #2
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    I code for many ASC's that do colonoscopies and have never used a G code. I most frequently use the 45378/45380/45384/45385.

  3. #3
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Quote Originally Posted by mbort View Post
    I code for many ASC's that do colonoscopies and have never used a G code. I most frequently use the 45378/45380/45384/45385.
    The clinic I work for has an ASC facility. We have been using the G codes for both the physician and the facility...so if I understand this correctly (mbort) I can use the 45378 instead of G0105/G0121 for the facility side and it will process by Medicare appropriately??? Thanks - Lisa

  4. #4
    Location
    East Stroudsburg, PA
    Posts
    78
    Default Colonoscopy
    For the facility that I work for we use the G Code for screenings only. All others we use the CPT codes. If the pt had a biopsy/polypectomy during the screening then we use the CPT code. The G code is used for screengs that have no findings.

    Hopes this helps!

  5. #5
    Location
    East Valley, Tempe AZ
    Posts
    44
    Default
    But I am being told that even if you bill the 45378 for screening it will still pay and you get 10.47 more for it. What is the motivation to use the g-code when I can use 45378? Why does medicare pay less for it on the facility side? It is still the same work.

  6. #6
    Default
    CPT Assistant addresses colonoscopies in their 2004 posting. It's called Colonoscopy Coding Made Simple. I'd check that out. For Medicare (in California) the Fiscal Intermediary has their own guidelines for coding Screening vs Diagnostic colonoscopies and we are required to use G codes under certain circumstances.

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